State Medicaid Expansion: The Third Way

May 12, 2014

To date, about half of states have moved forward with the Affordable Care Act’s optional Medicaid expansion. Now, additional states are pursuing an altogether different path that would allow them to use federal Medicaid funds to help low-income residents buy private coverage. Arkansas, Michigan and Iowa have already received federal Medicaid waivers and launched programs. Others are in various stages of drafting and negotiating. A few are considering block grants.

This briefing took a close look at the experiences of two states that have programs in place, the federal waiver process and the scope of state approaches. What is the range of considerations in designing and implementing alternate paths to expansion? For example, the briefing will address the various approaches to cost sharing, and the question of how much low-income participants should be required to pay.

Joe Thompson, surgeon general, state of Arkansas, described the state’s private option program, which covers newly-eligible adults by paying premiums for private plans available in the insurance marketplace. Arkansas received the first “private option” waiver, and most states are using it as a model.

Steve Fitton, Medicaid director, state of Michigan, discussed the state’s private option program, which incorporates a financial incentive for practicing healthy behaviors.

Alan Weil, executive director, National Academy for State Health Policy, addressed the range of state alternate approaches, and state considerations.

Ed Howard of the Alliance and Sara Collins of Commonwealth co-moderated.


Brief overview of state activity available here.

Contact: Marilyn Serafini (202)789-2300

Follow the briefing on Twitter: #Medicaid3rdWay

The event was sponsored by the nonpartisan Alliance for Health Reform and The Commonwealth Fund


Full Transcript (Adobe Acrobat PDF)

Speaker Presentations

Sara Collins Presentation (Adobe Acrobat PDF)
Steve Fitton Presentation (Adobe Acrobat PDF)
Alan Weil Presentation (Adobe Acrobat PDF)
Joe Thompson Presentation (Adobe Acrobat PDF

Event Details

Agenda (Adobe Acrobat PDF)
Speaker Biographies (Adobe Acrobat PDF)

Event Resources